常规颈动脉超声对多发性脑梗死患者CAS斑块特征及短期预后的评估价值  

Analysis of the value of routine carotid ultrasound for CAS plaque characterization and short-term prognostic assessment in patients with multiple cerebral infarction

作　　者：刘娟 马芳[1] 张玉芹 LIU Juan;MA Fang;ZHANG Yuqin(Hefei Second People’s Hospital,Hefei 230011,China)

机构地区：[1]合肥市第二人民医院,安徽合肥230011

出　　处：《中国实用神经疾病杂志》2023年第8期974-978,共5页Chinese Journal of Practical Nervous Diseases

基　　金：合肥市2021年应用医学研究项目(编号:Hwk2021yb008)。

摘　　要：目的探讨常规颈动脉超声对多发性脑梗死(MI)患者CAS斑块特征及短期预后评估价值。方法选取2020-02-2022-08合肥市第二人民医院收治的95例MI患者,进行常规颈动脉超声检查。以数字减影血管造影为金标准,分析常规颈动脉超声对CAS斑块的检出率,不同程度CAS斑块特征、稳定性、不稳定斑块超声参数及预后分析。结果95例MI患者中共检出CAS斑块88例,常规颈动脉超声检出81例,漏诊7例,差异无统计学意义(P>0.05);MI轻度组以硬斑块为主,MI中重度组以软斑块为主;稳定性和不稳定斑块组颈动脉中膜厚度(IMT)分别为[(1.35±0.35)mm、(1.37±0.41)mm],差异无统计学意义(P>0.05);稳定性斑块组斑块厚度、血流阻力指数(RI)、搏动指数(PI)分别为[(2.17±0.67)mm、(0.69±0.11)、(1.75±0.32)],低于不稳定性斑块组的[(3.04±0.73)mm、(0.77±0.14)、(1.95±0.54)],收缩期峰值流速(SPV)为(72.87±18.54)cm/s,高于不稳定性斑块组的(64.36±17.65)cm/s,差异有统计学意义(P<0.05);预后良好组斑块厚度、IMT、RI、PI[(1.86±0.51)mm、(0.76±0.12)mm、(0.68±0.16)、(1.61±0.43)]低于预后不良组[(2.57±0.62)mm、(0.98±0.33)mm、(0.81±0.14)、(1.94±0.55)],SPV为(75.64±19.34)cm/s,高于预后不良组的(65.08±17.51)cm/s,差异有统计学意义(P<0.05);斑块厚度、IMT、RI、PI、SPV及联合对MI患者预后评估的曲线下面积(AUC)为0.765、0.845、0.889、0.693、0.707、0.990,联合评估的敏感度、特异度均高于斑块厚度、IMT及颈动脉血流参数(P<0.05)。结论常规颈动脉超声对MI死患者CAS斑块特征诊断具有优势,对患者短期预后具有一定评估价值。Objective To investigate the value of conventional carotid ultrasound for CAS plaque characterization and short-term prognostic assessment in patients with multiple cerebral infarction(MI).Methods Ninety-five patients with MI admitted to Hefei second people’s hospital from February 2020 to August 2022 were selected for conventional carotid ultrasound.Digital subtraction angiography was used as the gold standard to analyze the detection rate of CAS plaques by conventional carotid ultrasound,different degrees of CAS plaque characteristics,stability,unstable plaque ultrasound parameters and prognostic analysis.Results A total of 88 CAS plaques were detected in 95 patients with MI,81 cases were detected by conventional carotid ultrasound and 7 cases were missed,with no statistically significant differences in detection(P>0.05).Hard plaques were predominant in the MI mild group and soft plaques in the MI moderate to severe group.Carotid intima-media thickness(IMT)was(1.35±0.35)mm and(1.37±0.41)mm in the stable and unstable plaque groups,respectively,and the differences were not statistically significant(P>0.05).The plaque thickness,flow resistance index(RI),and pulsatility index(PI)in the stable plaque group were[(2.17±0.67)mm,(0.69±0.11),and(1.75±0.32)]lower than those in the unstable plaque group[(3.04±0.73)mm,(0.77±0.14),and(1.95±0.54),respectively],and the peak systolic flow velocity(SPV)was[(72.87±18.54)cm/s]higher than that of the unstable plaque group[(64.36±17.65)cm/s],with statistically significant differences(P>0.05).The plaque thickness,IMT,RI,and PI in the good prognosis group[(1.86±0.51)mm,(0.76±0.12)mm,(0.68±0.16),(1.61±0.43)]were lower than those in the poor prognosis group[(2.57±0.62)mm,(0.98±0.33)mm,(0.81±0.14),(1.94±0.55)],and SPV was[(75.64±19.34)cm/s]higher than that of the poor prognosis group[(65.08±17.51)cm/s],with statistically signi-ficant differences(P<0.05).The area under the curve(AUC)of plaque thickness,IMT,RI,PI,SPV and combination for prognostic assessment of MI pat

关 键 词：超声 多发性脑梗死 颈动脉粥样硬化 斑块特征 短期预后 

分 类 号：R743.33[医药卫生—神经病学与精神病学]